Calcineurin-Inhibitor Minimization in Liver Transplant Patients with Calcineurin-Inhibitor-Related Renal Dysfunction: A Meta-Analysis

BACKGROUND: Introduction of calcineurin-inhibitor (CNI) has made transplantation a miracle in the past century. However, the side effects of long-term use of CNI turn out to be one of the major challenges in the current century. Among these, renal dysfunction attracts more and more attention. Herein, we undertook a meta-analysis to evaluate the efficacy and safety of calcineurin-inhibitor (CNI) minimization protocols in liver transplant recipients with CNI-related renal dysfunction. METHODS: We included randomized trials with no year and language restriction. All data were analyzed using random effect model by Review Manager 5.0. The primary endpoints were glomerular filtration rate (GFR), serum creatinine level (sCr) and creatinine clearance rate (CrCl), and the secondary endpoints were acute rejection episodes, incidence of infection and patient survival at the end of follow-up. RESULTS: GFR was significantly improved in CNI minimization group than in routine CNI regimen group (Z = 5.45, P<0.00001; I(2) = 0%). Likely, sCr level was significantly lower in the CNI minimization group (Z = 2.84, P = 0.005; I(2) = 39%). However, CrCl was not significantly higher in the CNI minimization group (Z = 1.59, P = 0.11; I(2) = 0%). Both acute rejection episodes and patient survival were comparable between two groups (rejection: Z = 0.01, P = 0.99; I(2) = 0%; survival: Z = 0.28, P = 0.78; I(2) = 0%, respectively). However, current CNI minimization protocols may be related to a higher incidence of infections (Z = 3.06, P = 0.002; I(2) = 0%). CONCLUSION: CNI minimization can preserve or even improve renal function in liver transplant patients with renal impairment, while sharing similar short term acute rejection rate and patient survival with routine CNI regimen

Assessment of quality of life with subjective quality of life perception in multiple sclerosis patients treated with glatiramer acetate

International audienc

Effects of different fire intensities on chemical and biological soil components and related feedbacks on a Mediterranean shrub (Phillyrea angustifolia L.)

In July 2000, six plots of Mediterranean maquis in the Castel Volturno Nature Reserve were burnt at two intensity levels to examine the effects of fire intensities on chemical and biological soil components and their relationships with ecophysiological processes of Phillyrea angustifolia L. Net photosynthesis and stomatal conductance, as well as P availability, were higher in burnt plots than in control plots, even 2 years after fire; the TM density of total soil microfungi was significantly lower in the first 8 months after fire, while xerotolerant and heat-stimulated soil microfungi were still higher 2 years after fire. Significant correlations between photosynthesis and stomatal conductance in resprouts and mycorrhizal status, as well as changes in the soil fungal components of the communities, suggest that both soil and mycorrhizal fungi play a role in immobilizing and translocating nutrients temporarily released in the below-ground system by fire. Nutrient balance interacts with physiological processes, and a feedback mechanism is well represented by stomatal conductance, which allows both the influx of water and mineral nutrients from the soil; moreover, the post-fire increase in photosynthetic activity promotes vigorous resprouting and may lead to increased availability of carbohydrates for soil biota and, consequently, to enhanced vegetation resilience